<article id="reporting">
    <div class="container">
        <h1 class="title-primary" id="case-top">Case Reporting</h1>
        <div class="row">
            <div class="col-md-12">
                <div class="well">
                    <p>
                        <?php if( ippi_isset($member_logged) ): ?>
                            <abbr title="">IPPI</abbr> (Ikatan Perempuan Positif Indonesia) menyediakan form pelaporan kasus kekerasan pada perempuan. 
                            Silahkan lengkapi form berikut untuk melakukan pelaporan
                        <?php else: ?>
                            <abbr title="">IPPI</abbr> (Ikatan Perempuan Positif Indonesia) menyediakan form pelaporan kasus kekerasan pada perempuan. 
                            Silahkan <a href="#member" id="btn-case-login"><strong>login</strong></a> terlebih dahulu untuk melakukan pelaporan.
                        <?php endif ?>
                    </p>
                </div>
            </div>
        
            <?php if( ippi_isset($member_logged) ): ?>
            <!-- Agreement Form -->
            <div id="agreement-form">
                <div class="col-md-12">
                    <div class="well">
                        <h3 style="margin-top: 10px;">Syarat dan Ketentuan</h3>
                        <?php 
                            $term = get_option('case_term');
                            if(!empty($term)) echo $term;
                        ?>
                        
                        <p style="text-align: center; margin-top: 60px;">
                            <input type="checkbox" id="agreement_check" style="position: relative; top: 1px; margin-right: 5px;" />
                            <label for="agreement_check" style="cursor: pointer;">Saya setuju dengan ketentuan laporan kasus di atas</label>
                        </p>
                        <div id="agreement_check_info" class="info" style="margin-bottom: 20px;"></div>
                        
                        <p class="margin-bottom-30" style="text-align: center;">
							<a href="#" class="btn btn-default" id="button-agreement">Lanjut</a>
						</p>
                    </div>
                </div>
            </div>
            <!-- /Agreement Form -->
            
            <!-- Pengaduan/Pelaporan -->
            <div id="tl-form" style="display: none;">
                <input type="hidden" id="case_id" name="case_id" value="" />
                <div class="col-md-12">
                    <h3>Tindak Lanjut Pengaduan / Pelaporan</h3>
                    <div class="form-group input-group" style="margin-bottom: 30px;">
                        <select class="form-control" id="tl" name="tl">
                            <option value="">Pilih Pengaduan/Pelaporan</option>
                            <option value="hanya melapor">Hanya Melapor</option>
                            <option value="butuh saran hukum">Butuh Saran Hukum</option>
                            <option value="konseling">Konseling</option>
                            <option value="layanan kesehatan">Layanan Kesehatan</option>
                        </select>
                        <div id="tl_info" class="info"></div>
                    </div>
                </div>
                
                <div id="tl_content" style="display: none;">
                    <div class="col-md-12">
                        <div class="well text-center">
                            <strong>
                                <p id="tl_text"></p>
                                <p id="tl_emailtext"></p>
                            </strong>
                            <div class="form-group input-group">
                                <input type="text" class="form-control" style="background: #F5F5F5;" 
                                onkeypress="return isNumber(event)" id="tl_telp" name="tl_telp" placeholder="Ketik no telp di sini" />
                                <div id="tl_telp_info" class="info"></div>
                            </div>
                        </div>
                    </div>
                </div>
                
                <p class="margin-bottom-10 text-center">
                    <a href="#" class="case btn btn-default" id="button-tl-back">Kembali</a>
                    <a href="#" class="case btn btn-default" id="button-tl-submit">Kirim</a>
				</p>
            </div>
            <!-- /Pengaduan/Pelaporan -->
            
            <!-- Thank You Page -->
            <div id="thanks-page" style="display: none;">
                <div class="container text-center">
					<h3 class="text-primary margin-top-0">Terima Kasih</h3>
					<p class="h5" style="line-height: 22px;">
						Terima Kasih atas informasi yang Anda berikan.<br />
                        Kerahasiaan data Anda akan dijaga sesuai dengan kesepakatan dimuka.
					</p>
					<p class="margin-bottom-10">
						<a href="#" class="case btn btn-default" id="button-back-to-case">Kembali</a>
                        <a href="#" class="case btn btn-default" id="button-pengaduan">Tindak Lanjut</a>
					</p>
				</div>
            </div>
            <!-- /Thank You Page -->
        
            <!-- Case Reporting Form -->
            <div id="case-reporting-form" style="display: none;">
                <div class="col-md-12">
                    <div id="loading"><img src="<?php echo base_url()?>assets/images/loader.gif" /></div>
                    <div id="messages_report" style="display: none;margin-bottom: 15px;" class="messages alert-danger registration">ISI PESAN</div>
                    
                    <!-- tabs-wrapper -->
                    <div class="tabs-wrapper">
                        <ul class="nav nav-tabs">
                            <li class="active"><a href="#tab-korban" data-toggle="tab" id="tab-korban-form">Sebagai Korban</a></li>
                            <li><a href="#tab-saksi" data-toggle="tab" id="tab-saksi-form">Sebagai Saksi</a></li>
                        </ul>
                    </div>
                    <!-- /tabs-wrapper -->
                    
                    <!-- tabs-content -->
                    <ul id="tab-content" class="tab-content fixed-max-width">
                        <!-- Sebagai Korban -->
                        <li class="panel">
                            <a data-toggle="collapse" data-parent="#tab-content" href="#tab-korban">Sebagai Korban</a>
                            <div id="tab-korban" class="tab-pane panel-collapse collapse in">
                                <div class="panel-body">
                                    <form role="form" method="post" id="korban-report-form" class="contact-form" action="">
                                        <!-- Data Korban -->
                                        <div id="wrapper-report1">
                                            <h1>Data Korban</h1>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_name" name="korban_name" placeholder="Nama Lengkap" />
                                                <div id="korban_name_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_tgllahir" name="korban_tgllahir" placeholder="Tanggal Lahir" />
                                                <div id="korban_tgllahir_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_idcard" name="korban_idcard" placeholder="No KTP/SIM/PASSPORT (Optional)" />
                                                <div id="korban_idcard_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="korban_propinsi" name="korban_propinsi">
                                                    <option value="">Pilih Propinsi</option>
                                                    <?php
                                                        foreach ($list_propinsi as $lp) {
                                                            ?> <option value="<?php echo $lp->state_id;?>"><?php echo $lp->state_name;?></option> <?php
                                                        }
                                                    ?>
                                                </select>
                                                <div id="korban_propinsi_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="korban_kota" name="korban_kota">
                                                    <option value="">Pilih Kota / Kabupaten</option>
                                                </select>
                                                <div id="korban_kota_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_alamat" name="korban_alamat" placeholder="Alamat Lengkap (Optional)" />
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" onkeypress="return isNumber(event)" id="korban_hp" name="korban_hp" placeholder="Telp / Hp (Optional)" />
                                                <div id="korban_hp_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="email" class="form-control" id="korban_email" name="korban_email" placeholder="Email (Optional)" />
                                                <div id="korban_email_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="korban_statushiv" name="korban_statushiv">
                                                    <option value="">Pilih Status HIV</option>
                                                    <option value="positive"> Positif </option>
                                                    <option value="negative"> Negatif </option>
                                                </select>
                                                <div id="korban_statushiv_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-korban1" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <!-- /Data Korban -->
                                           
                                        <!-- Data Pelaku -->
                                        <div id="wrapper-report2" style="display: none;">
                                            <h1>Data Pelaku</h1>
                                            <!-- Checkbox Pelaku Tak Dikenal -->
                                            <div style="margin-bottom: 20px;">
                                                <input type="hidden" name="us" id="us" value="" />
                                                <input type="checkbox" id="pelaku_takdikenal_check" style="position: relative; top: 1px; margin-right: 5px;" />
                                                <label for="pelaku_takdikenal_check" style="cursor: pointer;">Saya tidak kenal dengan pelaku</label>
                                            </div>
                                            <!-- /Checkbox Pelaku Tak Dikenal -->
                                            
                                            <!-- Data Pelaku Dikenal -->
                                            <div id="pelaku_dikenal" style="margin-bottom: 30px;">
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_name" name="pelaku_name" placeholder="Nama Lengkap Pelaku" />
                                                    <div id="pelaku_name_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_nick" name="pelaku_nick" placeholder="Nama Panggilan Pelaku" />
                                                    <div id="pelaku_nick_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_jk" name="pelaku_jk">
                                                        <option value="">Pilh Jenis Kelamin Pelaku</option>
                                                        <option value="laki-laki">Laki-laki</option>
                                                        <option value="perempuan">Perempuan</option>
                                                    </select>
                                                    <div id="pelaku_jk_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_noid" name="pelaku_noid" placeholder="No ID (KTP/SIM/PASSPORT) Pelaku (Optional)" />
                                                    <div id="pelaku_noid_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_hub_kat" name="pelaku_hub_kat">
                                                        <option value="">Pilih Hubungan Kategori Pelaku</option>
                                                        <option value="1">Keluarga</option>
                                                        <option value="2">Orang Dikenal</option>
                                                        <option value="3">Orang Tak Dikenal</option>
                                                    </select>
                                                    <div id="pelaku_hub_kat_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_hub" name="pelaku_hub">
                                                        <option value="">Pilih Hubungan Pelaku</option>
                                                    </select>
                                                    <div id="pelaku_hub_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_telp" name="pelaku_telp" placeholder="Telp / Hp Pelaku (Optional)" onkeypress="return isNumber(event)" />
                                                    <div id="pelaku_telp_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_alamat" name="pelaku_alamat" placeholder="Alamat Lengkap Pelaku (Optional)" />
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="email" class="form-control" id="pelaku_email" name="pelaku_email" placeholder="Email Pelaku (Optional)" />
                                                    <div id="pelaku_email_info" class="info"></div>
                                                </div>
                                            </div>
                                            <!-- /Data Pelaku Dikenal -->
                                            
                                            <!-- Data Pelaku Tidak Dikenal -->
                                            <div id="pelaku_takdikenal" style="display: none; margin-bottom: 30px;">
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_jkus" name="pelaku_jkus">
                                                        <option value="">Pilih Jenis Kelamin Pelaku</option>
                                                        <option value="laki-laki">Laki-laki</option>
                                                        <option value="perempuan">Perempuan</option>
                                                    </select>
                                                    <div id="pelaku_jkus_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_warkul" name="pelaku_warkul" placeholder="Warna Kulit Pelaku" />
                                                    <div id="pelaku_warkul_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_tinggi" name="pelaku_tinggi" placeholder="Tinggi Pelaku (cm)" onkeypress="return isNumber(event)" />
                                                    <div id="pelaku_tinggi_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_tanda" name="pelaku_tanda" placeholder="Tanda Lain Pelaku (Tato, Tanda Lahir, Cacat, lainnya)" />
                                                    <div id="pelaku_tanda_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_karakter" name="pelaku_karakter" placeholder="Karakter Tubuh Pelaku (Kurus, Gemuk, Proporsional, Lainnya)" />
                                                    <div id="pelaku_karakter_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_ciwaj" name="pelaku_ciwaj" placeholder="Ciri Wajah Pelaku (Kumis, Codet, Alis Tebal, lainnya)" />
                                                    <div id="pelaku_ciwaj_info" class="info"></div>
                                                </div>
                                            </div>
                                            <!-- Data Pelaku Tidak Dikenal -->
                                            
                                            <!-- Button Next Pelaku -->
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-korban-prev1" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-korban2" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                            <!-- /Button Next Pelaku -->
                                        </div>
                                        <!-- /Data Pelaku -->
                                          
                                        <!-- Deskripsi Kejadian -->
                                        <div id="wrapper-report3" style="display: none;">
                                            <h1>Deskripsi Kejadian</h1>
                                            <div class="form-group input-group">
                                                <h5 style="margin: 0 0 15px 0;">Jenis Kekerasan</h5>
                                                <select class="form-control" id="dk_jenis" name="dk_jenis[]" multiple="multiple" size="6">
                                                    <option value="verbal">Verbal/Psikis</option>
                                                    <option value="fisik">Fisik</option>
                                                    <option value="seksual">Seksual</option>
                                                    <option value="reproduksi">Reproduksi</option>
                                                    <option value="kekerasan ekonomi">Kekerasan Ekonomi</option>
                                                    <option value="diskriminasi">Diskriminasi</option>
                                                    <option value="lain-lain">Lain-lain</option>
                                                </select>
                                                <small><strong>Silahkan tekan CTRL untuk memilih lebih dari satu jenis kekerasan.</strong></small>
                                                <div id="dk_jenis_info" class="info"></div>
                                            </div>
                                            
                                            <div class="form-group input-group">
                                                <select class="form-control" id="dk_lokasi" name="dk_lokasi">
                                                    <option value="">Pilih Jenis Lokasi Kejadian</option>
                                                    <option value="tempat tinggal">Tempat tinggal</option>
                                                    <option value="layanan masyarakat">Layanan Kesehatan</option>
                                                    <option value="area umum">Area Umum</option>
                                                </select>
                                                <div id="dk_lokasi_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="dk_propinsi" name="dk_propinsi">
                                                    <option value="">Pilih Propinsi</option>
                                                    <?php
                                                        foreach ($list_propinsi as $lp) {
                                                            ?> <option value="<?php echo $lp->state_id;?>"><?php echo $lp->state_name;?></option> <?php
                                                        }
                                                    ?>
                                                </select>
                                                <div id="dk_propinsi_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="dk_kota" name="dk_kota">
                                                    <option value="">Pilih Kota / Kabupaten</option>
                                                </select>
                                                <div id="dk_kota_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="dk_alamat" name="dk_alamat" placeholder="Lokasi Kejadian" />
                                                <div id="dk_alamat_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <textarea class="form-control" id="dk_deskripsi" name="dk_deskripsi" placeholder="Deskripsi Kejadian" rows="7"></textarea>
                                                <div id="dk_deskripsi_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="hidden" id="dk_qwe" class="qwe" value="" />
                                                <input type="hidden" id="dk_ewq" class="ewq" value="" />
                                                <div class="security-wrap input-group">
                                                    <input type="number" id="dk_security" name="dk_security" class="form-control" autocomplete="off" onkeypress="return isNumber(event)" />
                                                    <span class="input-group-addon checking_human" id="checking_human">Are you human? 1+6 =</span>
                                                    <div id="dk_security_info" class="info"></div>
                                                </div>
                                            </div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-korban-prev2" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-korban3" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>  
                                        <!-- /Deskripsi Kejadian -->
                                        
                                        <!-- Preview Page -->
                                        <div id="wrapper-report4" style="display: none;">
                                            <div id="preview-page-korban"></div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-korban-prev3" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-korban4" class=" btn btn-default">Selesai</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <!-- /Preview Page -->

                                    </form>
                                </div>
                            </div>
                        </li>
                        <!-- /Sebagai Korban -->
                        
                        <!-- Sebagai Saksi -->
                        <li class="panel">
                            <a data-toggle="collapse" data-parent="#tab-content" href="#tab-saksi">Sebagai Saksi</a>
                            <div id="tab-saksi" class="tab-pane panel-collapse collapse">
                                <div class="panel-body">
                                    <form role="form" method="post" id="saksi-report-form" class="contact-form" action="">
                                        <!-- hidden value -->
                                        <input type="hidden" name="saksi_value" value="1" />
                                        
                                        <!-- Data Saksi -->
                                        <div id="wrapper-report-saksi1">
                                            <h1>Data Saksi</h1>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="saksi_name" name="saksi_name" placeholder="Nama Lengkap" />
                                                <div id="saksi_name_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="saksi_tgllahir" name="saksi_tgllahir" placeholder="Tanggal Lahir" />
                                                <div id="saksi_tgllahir_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="saksi_idcard" name="saksi_idcard" placeholder="No KTP/SIM/PASSPORT (Optional)" />
                                                <div id="saksi_idcard_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="saksi_propinsi" name="saksi_propinsi">
                                                    <option value="">Pilih Propinsi</option>
                                                    <?php
                                                        foreach ($list_propinsi as $lp) {
                                                            ?> <option value="<?php echo $lp->state_id;?>"><?php echo $lp->state_name;?></option> <?php
                                                        }
                                                    ?>
                                                </select>
                                                <div id="saksi_propinsi_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="saksi_kota" name="saksi_kota">
                                                    <option value="">Pilih Kota / Kabupaten</option>
                                                </select>
                                                <div id="saksi_kota_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="saksi_alamat" name="saksi_alamat" placeholder="Alamat Lengkap (Optional)" />
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" onkeypress="return isNumber(event)" id="saksi_telp" name="saksi_telp" placeholder="Telp / Hp (Optional)" />
                                                <div id="saksi_telp_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="email" class="form-control" id="saksi_email" name="saksi_email" placeholder="Email (Optional)" />
                                                <div id="saksi_email_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="saksi_hub_kat" name="saksi_hub_kat">
                                                    <option value="">Pilih Hubungan Kategori</option>
                                                    <option value="1">Keluarga</option>
                                                    <option value="2">Orang Dikenal</option>
                                                    <option value="3">Orang Tak Dikenal</option>
                                                </select>
                                                <div id="saksi_hub_kat_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="saksi_hub" name="saksi_hub">
                                                    <option value="">Pilih Hubungan</option>
                                                </select>
                                                <div id="saksi_hub_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-saksi1" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <!-- /Data Saksi -->
                                        
                                        <!-- Data Korban -->
                                        <div id="wrapper-report-saksi2" style="display: none;">
                                            <h1>Data Korban</h1>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_name2" name="korban_name" placeholder="Nama Lengkap" />
                                                <div id="korban_name2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_tgllahir2" name="korban_tgllahir" placeholder="Tanggal Lahir" />
                                                <div id="korban_tgllahir2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_idcard2" name="korban_idcard" placeholder="No KTP/SIM/PASSPORT (Optional)" />
                                                <div id="korban_idcard2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="korban_propinsi2" name="korban_propinsi">
                                                    <option value="">Pilih Propinsi</option>
                                                    <?php
                                                        foreach ($list_propinsi as $lp) {
                                                            ?> <option value="<?php echo $lp->state_id;?>"><?php echo $lp->state_name;?></option> <?php
                                                        }
                                                    ?>
                                                </select>
                                                <div id="korban_propinsi2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="korban_kota2" name="korban_kota">
                                                    <option value="">Pilih Kota / Kabupaten</option>
                                                </select>
                                                <div id="korban_kota2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="korban_alamat2" name="korban_alamat" placeholder="Alamat Lengkap (Optional)" />
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" onkeypress="return isNumber(event)" id="korban_hp2" name="korban_hp" placeholder="Telp / Hp (Optional)" />
                                                <div id="korban_hp2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="email" class="form-control" id="korban_email2" name="korban_email" placeholder="Email (Optional)" />
                                                <div id="korban_email2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="korban_statushiv2" name="korban_statushiv">
                                                    <option value="">Pilih Status HIV</option>
                                                    <option value="positive"> Positif </option>
                                                    <option value="negative"> Negatif </option>
                                                </select>
                                                <div id="korban_statushiv2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-saksi-prev1" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-saksi2" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <!-- /Data Korban -->
                                        
                                        <!-- Data Pelaku -->
                                        <div id="wrapper-report-saksi3" style="display: none;">
                                            <h1>Data Pelaku</h1>
                                            <!-- Checkbox Pelaku Tak Dikenal -->
                                            <div style="margin-bottom: 20px;">
                                                <input type="hidden" name="us" id="us2" value="" />
                                                <input type="checkbox" id="pelaku_takdikenal_check2" style="position: relative; top: 1px; margin-right: 5px;" />
                                                <label for="pelaku_takdikenal_check2" style="cursor: pointer;">Saya tidak kenal dengan pelaku</label>
                                            </div>
                                            <!-- /Checkbox Pelaku Tak Dikenal -->
                                            
                                            <!-- Data Pelaku Dikenal -->
                                            <div id="pelaku_dikenal2" style="margin-bottom: 30px;">
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_name2" name="pelaku_name" placeholder="Nama Lengkap" />
                                                    <div id="pelaku_name2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_nick2" name="pelaku_nick" placeholder="Nama Panggilan" />
                                                    <div id="pelaku_nick2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_jk2" name="pelaku_jk">
                                                        <option value="">Pilih Jenis Kelamin</option>
                                                        <option value="laki-laki">Laki-laki</option>
                                                        <option value="perempuan">Perempuan</option>
                                                    </select>
                                                    <div id="pelaku_jk2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_noid2" name="pelaku_noid" placeholder="No ID (KTP/SIM/PASSPORT) (Optional)" />
                                                    <div id="pelaku_noid2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_hub_kat2" name="pelaku_hub_kat">
                                                        <option value="">Pilih Hubungan Kategori</option>
                                                        <option value="1">Keluarga</option>
                                                        <option value="2">Orang Dikenal</option>
                                                        <option value="3">Orang Tak Dikenal</option>
                                                    </select>
                                                    <div id="pelaku_hub_kat2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_hub2" name="pelaku_hub">
                                                        <option value="">Pilih Hubungan</option>
                                                    </select>
                                                    <div id="pelaku_hub2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_telp2" name="pelaku_telp" placeholder="Telp / Hp (Optional)" onkeypress="return isNumber(event)" />
                                                    <div id="pelaku_telp2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_alamat2" name="pelaku_alamat" placeholder="Alamat Lengkap (Optional)" />
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="email" class="form-control" id="pelaku_email2" name="pelaku_email" placeholder="Email (Optional)" />
                                                    <div id="pelaku_email2_info" class="info"></div>
                                                </div>
                                            </div>
                                            <!-- /Data Pelaku Dikenal -->
                                            
                                            <!-- Data Pelaku Tidak Dikenal -->
                                            <div id="pelaku_takdikenal2" style="display: none; margin-bottom: 30px;">
                                                <div class="form-group input-group">
                                                    <select class="form-control" id="pelaku_jkus2" name="pelaku_jkus">
                                                        <option value="">Pilih Jenis Kelamin</option>
                                                        <option value="laki-laki">Laki-laki</option>
                                                        <option value="perempuan">Perempuan</option>
                                                    </select>
                                                    <div id="pelaku_jkus2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_warkul2" name="pelaku_warkul" placeholder="Warna Kulit" />
                                                    <div id="pelaku_warkul2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_tinggi2" name="pelaku_tinggi" placeholder="Tinggi (cm)" onkeypress="return isNumber(event)" />
                                                    <div id="pelaku_tinggi2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_tanda2" name="pelaku_tanda" placeholder="Tanda Lain (Tato, Tanda Lahir, Cacat, lainnya)" />
                                                    <div id="pelaku_tanda2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_karakter2" name="pelaku_karakter" placeholder="Karakter Tubuh (Kurus, Gemuk, Proporsional, Lainnya)" />
                                                    <div id="pelaku_karakter2_info" class="info"></div>
                                                </div>
                                                <div class="form-group input-group">
                                                    <input type="text" class="form-control" id="pelaku_ciwaj2" name="pelaku_ciwaj" placeholder="Ciri Wajah (Kumis, Codet, Alis Tebal, lainnya)" />
                                                    <div id="pelaku_ciwaj2_info" class="info"></div>
                                                </div>
                                            </div>
                                            <!-- Data Pelaku Tidak Dikenal -->
                                            
                                            <!-- Button Next Pelaku -->
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-saksi-prev2" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-saksi3" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                            <!-- /Button Next Pelaku -->
                                        </div>
                                        <!-- /Data Pelaku -->
                                          
                                        <!-- Deskripsi Kejadian -->
                                        <div id="wrapper-report-saksi4" style="display: none;">
                                            <h1>Deskripsi Kejadian</h1>
                                            <div class="form-group input-group">
                                                <h5 style="margin-bottom: 15px;">Jenis Kekerasan</h5>
                                                <select class="form-control" id="dk_jenis2" name="dk_jenis[]" multiple="multiple" size="6">
                                                    <option value="verbal">Verbal/Psikis</option>
                                                    <option value="fisik">Fisik</option>
                                                    <option value="seksual">Seksual</option>
                                                    <option value="reproduksi">Reproduksi</option>
                                                    <option value="kekerasan ekonomi">Kekerasan Ekonomi</option>
                                                    <option value="diskriminasi">Diskriminasi</option>
                                                    <option value="lain-lain">Lain-lain</option>
                                                </select>
                                                <small><strong>Silahkan tekan CTRL untuk memilih lebih dari satu jenis kekerasan.</strong></small>
                                                <div id="dk_jenis2_info" class="info"></div>
                                            </div>
                                            
                                            <div class="form-group input-group">
                                                <select class="form-control" id="dk_lokasi2" name="dk_lokasi">
                                                    <option value="">Pilih Jenis Lokasi Kejadian</option>
                                                    <option value="tempat tinggal">Tempat tinggal</option>
                                                    <option value="layanan masyarakat">Layanan Kesehatan</option>
                                                    <option value="area umum">Area Umum</option>
                                                </select>
                                                <div id="dk_lokasi2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="dk_propinsi2" name="dk_propinsi">
                                                    <option value="">Pilih Propinsi</option>
                                                    <?php
                                                        foreach ($list_propinsi as $lp) {
                                                            ?> <option value="<?php echo $lp->state_id;?>"><?php echo $lp->state_name;?></option> <?php
                                                        }
                                                    ?>
                                                </select>
                                                <div id="dk_propinsi2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <select class="form-control" id="dk_kota2" name="dk_kota">
                                                    <option value="">Pilih Kota / Kabupaten</option>
                                                </select>
                                                <div id="dk_kota2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="text" class="form-control" id="dk_alamat2" name="dk_alamat" placeholder="Lokasi Kejadian" />
                                                <div id="dk_alamat2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <textarea class="form-control" id="dk_deskripsi2" name="dk_deskripsi" placeholder="Deskripsi Kejadian" rows="7"></textarea>
                                                <div id="dk_deskripsi2_info" class="info"></div>
                                            </div>
                                            <div class="form-group input-group">
                                                <input type="hidden" id="dk_qwe2" class="qwe" value="" />
                                                <input type="hidden" id="dk_ewq2" class="ewq" value="" />
                                                <div class="security-wrap input-group">
                                                    <input type="number" id="dk_security2" name="dk_security" class="form-control" autocomplete="off" onkeypress="return isNumber(event)" />
                                                    <span class="input-group-addon checking_human" id="checking_human">Are you human? 1+6 =</span>
                                                    <div id="dk_security2_info" class="info"></div>
                                                </div>
                                            </div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-saksi-prev3" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-saksi4" class=" btn btn-default">Lanjut</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>  
                                        <!-- /Deskripsi Kejadian -->
                                        
                                        <!-- Preview Page -->
                                        <div id="wrapper-report-saksi5" style="display: none;">
                                            <div id="preview-page-saksi"></div>
                                            <div class="form-group input-group">
                                                <div class="row">
                                                    <div class="col-sm-6"></div>
                                                    <div class="col-sm-6 text-right">
                                                        <a href="#" id="button-report-saksi-prev4" class=" btn btn-default">Kembali</a>
                                                        <a href="#" id="button-report-saksi5" class=" btn btn-default">Selesai</a>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                        <!-- /Preview Page -->

                                    </form>
                                </div>
                            </div>
                        </li>
                        <!-- Sebagai Saksi -->
                    </ul>
                    <!-- /tabs-content -->
                </div>
            </div>
            <!-- /Case Reporting Form -->
            <?php endif ?>
            
        </div>
    </div>
</article>

<!--#googlemaps-->
<article id="map">
    <div class="container">
        <h1 class="title-primary">Cases Distribution</h1>
        <div class="row">
            <div class="col-md-6">
                <h4>Cases</h4>
                <div id="map-canvas" style="height:500px; width:100%; margin:0 auto 0 auto;"></div>
            </div>
            <div class="col-md-6">
                <h4>Services</h4>
                <div id="map-services" style="height:500px; width:100%; margin:0 auto 0 auto;"></div>
            </div>
        </div>
    </div>
</article>
<!--#googlemaps-->